DESCRIPTION: (Applicant's Description) The major goal of this project is to improve end of life (EOL) care in nursing homes (NH) through an educational partnership to increase knowledge, skills, and confidence of nursing staff in NH. The partnership will be formed between Swedish Medical Center and Seattle-area NH and will test, refine, and implement a comprehensive educational program that will prepare licensed nursing staff (RNs and LVN/LPNs) and certified nursing assistants (CNAs) as Palliative Care Education Resource Team (PERT) members. The specific aims of the project are to: 1) test and refine an educational intervention that focuses on increasing the clinical knowledge and skills of licensed staff and certified nursing assistants in nursing homes; 2) increase the knowledge and skills of licensed staff and certified nursing assistants in NH regarding end of life care; 3) improve collaboration between palliative care providers and NH staff by providing opportunities for NH staff and palliative team members to share knowledge, ideas, and concerns; and 4) document the effectiveness of the educational intervention in improving EOL care in NH. The project will proceed in two phases. Phase 1 will involve a pilot test of the PERT curriculum at one NH facility. Based on participant and facility feedback and project outcomes, the curriculum will be refined. Phase 2 will implement the revised PERT curriculum in all NH that contract with Swedish Medical Center for hospice services. At present, 35 facilities employing approximately 1000 licenced staff and 2000 CNAs have expressed interest in participating. Approximately 300 PERT members will be recruited from this pool of potential applicants. A strong evaluation component is included in both phases of the project to document the impact of the PERT program on staff knowledge and skills, and clinical practice. Dissemination of the PERT curriculum and its impact on nurse and patient outcomes is planned and includes lay and professional presentations and publications, and a website. In addition, there are documented plans and commitments to ensure the ongoing implementation of the PERT Program in additional facilities not included in the original project.